Senate Oks Tighter Va Standards

The U.S. Senate approved a bill on Wednesday requiring Veterans Administration officials to make public heart surgery death rates and tighten medical quality standards.

``I`m terribly pleased that this measure is on its way to the president for signature,`` said U.S. Sen. Frank Murkowski, R-Alaska, chairman of the Committee on Veterans Affairs.

Murkowski said the bill would ``enhance`` existing efforts to monitor medical services in the VA`s 172 hospitals. The House passed the bill Oct. 30.

The bill also would reauthorize VA programs to treat drug and alcohol abusers and Agent Orange exposure, create pilot projects for home health care and limit new VA hospitals to 700 beds.

The measure follows disclosure by the News and Sun-Sentinel that heart surgery death rates were ``excessive`` in a dozen VA hospitals, and that officials had used an obscure 1980 secrecy law to suppress the statistics.

The bill requires VA officials to set acceptable death and injury rates for all types of surgery and ``periodically evaluate`` whether VA hospitals are reporting ``significant deviations`` from the norms.

VA officials also must evaluate cardiac surgeons and heart and kidney transplant teams based upon factors such as the patients` age and degree of illness.

Hospitals falling below VA standards would be identified in three biannual reports to Congress, beginning in February 1987. The reports would be available to the public.

The bill also amends the 1980 secrecy law to prevent VA officials from suppressing ``morbidity (illness) or mortality rates associated with specific activities at individual`` VA hospitals.

The safety records of VA hospitals will remain confidential, however, if disclosure would ``implicitly or explicitly`` identify VA doctors. VA officials claim the records of 15 of 44 VA heart surgery programs would be exempted because surgery is performed by a single doctor.

The disclosure provisions were introduced by Sen. Alan Cranston, D-Calif., last January in response to the VA`s refusal to provide death rates sought by the News and Sun-Sentinel under the Freedom of Information Act.

``In my view such a withholding of information about government programs is not good public policy,`` Cranston stated in the Jan. 24 issue of the Congressional Record.

U.S. Rep. Dan Mica, D-Lake Worth, who sponsored the disclosure bill in the House, called the passage ``a step in the right direction,`` but added: ``No legislation can correct an adminstrative mindset determined not to cooperate.

``There is no reason for the VA not to be forthcoming in its dealings with the public and its patients.``

VA doctors have resisted efforts to use death statistics to judge the quality of VA care. They claim VA hospitals report elevated death rates because their patients are older and sicker than average.

However, a national panel formed by VA officials to investigate agency cardiac surgery programs recently recommended disciplinary action against programs reporting coronary artery bypass death rates above 5 percent for two years straight.

In addition, a recent VA Office of Inspector General report stated that while mortality rates themselves were ``not meaningful,`` close scrutiny of the statistics would help in ``identifying and correcting`` problems.

``Medical outcomes, such as mortality, are valid indicators of the quality of care,`` the report stated.

The News and Sun-Sentinel first clashed with the VA over access to medical quality records in November 1980, when the newspapers reported that Miami`s heart surgery unit had been closed down because too many patients had died.

The newspapers filed a lawsuit in 1982 that forced the VA to disclose for the first time a variety of sensitive medical-quality documents. The suit did not assure the records would be disclosed in other cases, however.

The News and Sun-Sentinel filed a second suit in November 1984 to require the VA to disclose all heart surgery death rates. That suit is pending.

The VA measure passed the Senate on a voice vote after approval of an amendment by Sen. Jeremiah Denton, R-Ala., seeking to require the VA to purchase a private hospital in Mobile.

Sen. Lawton Chiles, D-Fla., countered with an amendment, also approved, stating that such a plan would not rule out a VA hospital for the Florida Panhandle.

The House must approve the amendments before the bill can be sent to the president for his signature.